Healthcare Provider Details

I. General information

NPI: 1669382883
Provider Name (Legal Business Name): KRISTIE LYNN TOMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FERRY ST
LAFAYETTE IN
47904-3055
US

IV. Provider business mailing address

7540 W 550 S
DELPHI IN
46923-8837
US

V. Phone/Fax

Practice location:
  • Phone: 765-838-7035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number28119353A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: